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Lege Artis Medicinae

OCTOBER 21, 2020

[Epidemiology of diabetes mellitus and diabetes-related eye complications in Hungary]

TÓTH Gábor, NÉMETH János

[Diabetes mellitus is a disease of civilization and a leading cause of blindness among people of working age in developed countries. It’s prevalence is estimated to be 9.9% in the adult population in Hungary, based on this, the estimated number of people with diabetes mellitus was 807 000 in 2015 in our country. Almost every fifth people with diabetes mellitus has some form of diabetic retinopathy in Hungary. Among diabetic persons 0.3% is blind and 0.3% has serious visual impairment due to not adequately treated diabetes mellitus. The total prevalence-based diabetes retinopathy-associated economic burden was 43.66 billion HUF in 2018 in our country. The two major cost drivers were anti-VEGF injections and vitrectomies; they covered almost the four-fifths of the total cost among people with diabetes mellitus. We have to emphasize the importance of prevention, healthy nutrition and frequent sport activity in the fight against diabetes mellitus and overweight. With at least annually performed eye examinations in people with diabetes mellitus and timely treatment of diabetic retinopathy, visual impairment and blindness due to complications of diabetes mellitus can be prevented. ]

Journal of Nursing Theory and Practice

AUGUST 30, 2019

[How to break sensitive news in the Ophthalmology, specifically at diabetic retinopathy ]

TÓTH Lívia, BÁLINT Zsófia, MÁTÉ Orsolya

[The aim of the study: To investigate the circumstances of breaking bad news by health care professionals and the conditions of communication at the Ophthalmology Clinic of the University of Pécs, among diabetic retinopathy patients. Material and method: Quantitative and cross-sectional examination, February-December 2018. Statistical methods: descriptive and mathematical statistics (χ2-test), SPSSv22, (p<0,05). Results: Most of the examined medical professionals working at the clinic (20 persons/90.90%) can’t be supported by a protocol for breaking bad news, however, the need for a protocol is formulated as more than half of the respondents (11 persons/59.09%). Conclusions: Health care professionals would need to develop a protocol to break bad news in health care institutions, also in the Clinic of Ophthalmology, furthermore, attention should be paid to improving the circumstances during providing information to patients.]

Lege Artis Medicinae

APRIL 20, 2013

[Health-economic analysis of diseases related to disturbed neonatal adaptation: a cost of illness study]

BONCZ Imre, KOVÁCS L. Gábor, ERTL Tibor, ÁGOSTON István, MOLICS Bálint, BÓDIS József

[OBJECTIVES - The aim of our study is to perform a health-economic analysis of diseases related to disturbed neonatal adaptation by assessing the burden of health care costs in Hungary. DATA AND METHODS - Data were derived from the financial dataset of the National Health Insurance Fund Administration (OEP) covering year 2009. Four diseases were included in the analysis: polycystic ovary syndrome (E2820), retinopathy of prematurity (H3510), hyperstimulation of ovaries (N9810) and respiratory distress syndrome of the newborn (P2200). RESULTS - The annual health insurance costs of the assessed diseases were the following: polycystic ovary syndrome: 78.9 million Hungarian Forints (HUF) or 281 160 Euro (EUR), retinopathy of prematurity: 41.3 million HUF (147 090 EUR), hyperstimulation of ovaries: 8.7 million HUF (30 839 EUR) and respiratory distress syndrome of the newborn: 1.562 million HUF (5 567 336 EUR). We found by far the highest annual per capita health insurance expenditure for respiratory distress syndrome of the newborn (1,43 million HUF or 5098 EUR/patient/year). Hyperstimulation of ovaries (58 073 HUF or 207 EUR/patient/year), retinopathy of prematurity (19 513 HUF or 70 EUR/patient/year) and polycystic ovary syndrome (7679 HUF or 27 EUR/patient/year) was associated with significantly lower annual per capita health insurance expenditure. CONCLUSIONS - The diseases related to disturbed neonatal adaptation have substantial annual health insurance expenditures (1 689 million HUF or 6.02 million EUR) and of these diseases respiratory distress syndrome of the newborn has the highest burden of disease.]

Lege Artis Medicinae

DECEMBER 10, 2009

[Insulin analogues and pregnancy]

TAMÁS GYULA, KERÉNYI ZSUZSA

[Near-normoglycaemic metabolic control in pregnant women with diabetes - started before conception in pregestational diabetes - decreases the frequency of maternal and foetal complications. Such control can be achieved by using optimalised systems of insulin therapy. A number of (ultra)rapid and long-acting insulin analogues became available during the last decade, which - on the basis of theoretical considerations - might be used to maintain normoglycaemia. Summarising the data available today, the use of rapid insulin analogues (lispro, aspart) seem to be effective and safe during pregnancy. Some questions arise, however, about their modes of application. The use of long-acting insulin analogues in pregnancy is currently not indicated. Further trials are needed to prove their efficacy and safety in diabetic pregnancy.]

Lege Artis Medicinae

JUNE 20, 2011

[A new approach to the treatment of diabetic retinopathy - PPAR-α agonist activity of fenofibrate]

CSÁSZÁR Albert

[Diabetic retinopathy (DR) is a leading cause of visual impairment worldwide. It affects nearly half of patients with diabetes and its severity increases with the progress of diabetes. Glycotoxicity, lipotoxicity and hypertension are the main risk factors for the development of DR. The control of glucose homeostasis and blood pressure are the main noninvasive approaches that might have a role in the treatment of this condition. On the basis of new studies, RAS inhibitors and fenofibrate are promising candidates that can be used to retard DR progression and/or induce its regression. Two large-scale studies (FIELD, ACCORD Eye) have demonstrated that fenofibrate therapy significantly reduces the need for laser treatment of DR. The efficiency of this therapy, which is independent of lipid changes, is primarily attributable to the PPAR-α agonist activity of fenofibrates. According to guidelines that discuss the new therapeutic approaches of DR, fibrate therapy is a promising new option for preventing the progression of DR.]

Lege Artis Medicinae

JULY 20, 2006

[THE POTENTIAL ROLE OF THE SEMICARBAZIDESENSITIVE AMINE OXIDASE ACTIVITY IN THE DEVELOPMENT OF DIABETIC RETINOPATHY]

DURA Eszter

[Recent data suggest that the copper-containing semicarbazide-sensitive amine oxidase enzyme (SSAO) may play a role in vascular endothelial damage through conversion of certain endogenous monoamines, such as methylamine, into cytotoxic aldehydes, hydrogen peroxide and ammonia. SSAO is present in various human tissues and in the serum. Elevated SSAO activities have been reported in patients with both types of diabetes mellitus. We have demonstrated that the activity of serum SSAO is significantly higher in type 2 diabetic patients with high-risk proliferative diabetic retinopathy compared to those without retinopathy. Our clinical results support the hypothesis that elevated SSAO activity may be involved in the pathogenesis of microvascular diabetic late complications, such as retinopathy. The enzymatic conversion of the endogenous monoamines (e.g. methylamine, aminoacetone) into toxic aldehydes and hydrogenperoxide may be one of the possible mechanisms of the development of microangiopathy. Also, the vascular adhesion protein-1 (VAP-1) function of the molecule can cause leukostasis and leukocyte activation through increased leukocyte adhesion, resulting in worsening of the capillary circulation and hypoxia. Further prospective, larger studies are needed to elucidate the role of the possible association between serum SSAO activity and highrisk proliferative retinopathy in patients with type 2 diabetes. The pharmacological manipulation of SSAO activity might be an interesting new concept for prevention and treatment of diabetic retinopathy.]

Lege Artis Medicinae

FEBRUARY 20, 2001

[The importance of vitrectomy in the management of diabetic retinopathy in proliferative stage]

BERECZKI Árpád

[Vitrectomy is a closed microsurgical technique, by which intraocular tissue, blood and foreign bodies can be removed through a small incision in the pars plana with an automated suction-cutting device (vitrectom), while maintaining normal or slightly elevated intraocular pressure. This technique requires many accessory instruments (microscope, endoillumination, intraocular instruments, endolaser). The main application of vitrectomy is the treatment of severe complications in diabetes mellitus: diabetic retinopathy in the proliferative stage. Vitrectomy is indicated in diabetic retinopathy for the removal of intraocular bleeding and for the treatment of complications of diabetic proliferative vitreoretinopathy (recurring bleeding, tractional and rhegmatogenous retinal detachment). In the case of intraocular bleeding, early vitrectomy is better than delayed, providing good visus (V: 0,5) in 25% of all patients (based on literature data). In retinal detachment cases of tractional origin, surgery provides satisfactory visus for self-care in 2/3rd of all patients.]